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Utilizing the exoscope in neurosurgical oncology – the perspective from a tumor surgeon

On-demand webinar delivered by Dr. Nader Sanai

The following time-stamps will guide you to certain key points & examples during this webinar:

At 1:30: “Moving from a pure optical platform to a digital platform is something that we are going to see increasingly in our operating rooms”

At 3:10: “As a tumor surgeon, we have multiple information chains, we have the structural MRI, functional MRI, tractography, MR spectroscopy, MAG imaging, fluorescence-guided surgery, intraoperative navigation and all of these things have to be integrated in our brains and extrapolated through our actions with the tumor. I think what this platform (ZEISS KINEVO 900) is enabling us to do, is give us the ability to integrate a lot of this in real-time so that we do not have to do this ourselves and we do not have to be swiveling our heads to look at this scan or that scan as we are operating.”

At 6:01: “Now, the PointLock concept is really one where you want to specifically focus on a particular target in three-dimensional space. But you want to be able to pivot around it without having to find it again. We all do that in the OR and while it may take only few seconds, those are precious seconds where you lose your chain of thoughts. [..] Achieving this at a functional level… and by that I mean the ability where the robot does it for you and you do not have to adjust at all in terms of fine tuning the focus or fine tuning the special referencing [..] I have used it in the OR, really without any training on it and it is something very intuitive.

At 7:17: “Many of us use MRI spectroscopy (for example) to identify hotspots where we will perform biopsy. For example, in a low grade tumor we want to decrease the chance of missing a focus of transformation. By bookmarking those sites on the microscope, we can make sure that we can go directly to that spot without worrying about aligning the navigation and all of the other anatomical information around it.”

At 9:06: “In brain tumor operations there are many dimensions of the tumor that we need to work along and we often operate – move the microscope – operate. This platform enables you to continuously operate as you are moving. And, if you are using it as an exoscope function (particularly), you, yourself don’t have to move at all. Effectively, the microscope moves and you stay still. [..] it is an important distinction when you are doing a multi-hour operations and you are able to stay in a position of comfort and stability [..] instead of moving around your torso to accommodate the dimension.”

At 11:03: “The next generation of microscope will be something that is not so much part of you but is working in parallel with you. [..] For example, in a far-lateral type approach for lower cranial schwannoma, there are issues in positioning and the angle of view. But here we can operate in a relatively neutral position using 3D 4K visualization.“

At 13:13: Case explanation for Retrosigmoid Crainiotomy for Petrous Face Meningioma using the combination of exoscopic visualization and robotics.At 13:54: “This is at the point where one can transition to the exoscope. Because the angles of approach that you want as you are trying to pull this tumor away from the brain tumor margins, really can be quite extreme. You can see in the inset where the angle of the microscope head is relative to my head. If I had to stretch to get to that angle am going to be relatively uncomfortable and less stable ergonomically with my hands and torso.”

At 15:12: “ I would also add that the learning curve for this is not very steep. It is relatively simple device to adopt into your workflow because many of us have already gotten used to using the foot pedal for basic robotic movements of the microscope head. What this does is: add these additional dimensions of moving in an angle and pivoting around a point. So, it is really is like a real-time surveillance image happening as you operate.

At 16.31: “The digital integration of real-time functional imaging, real-time tractography, real-time stimulation mapping data into the cortex will basically make it seamless.”

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